SM
Sibusiso M
1 reviews | Active since Oct 2012
30 Oct 2015, 07:14
Limitations 2 a point where u r afraid 2 consult
Six months ago a claim was rejected, reason being that I'm only entitled to one every three year, should the **** are you to tell my dentist what he can or can't do? He went to school, and read go his degree, you are just a simple soul tasked with pushing buttons on a computer all day.<br> I let that slide, six months later another claim is rejected
Helpful (0)
Replies (1)0
Replies (1)
DENIS's replyOfficial
30 Oct 2015, 15:16Hello Mtswene,
As telephonically discussed, the dental claim dated 24 March 2015 was short paid as the procedure code 8115 (Panoramic x-ray) is allowed once per beneficiary in a 3 year period, this was previously claimed for in August 2013. With regards to the dental claim dated 15 October 2015, the procedure code 8159 (scale and polish) was inadvertently claimed twice resulting in a short payment, the dental practice has been contacted and an amended account will be submitted to us for correction.
As telephonically discussed, the dental claim dated 24 March 2015 was short paid as the procedure code 8115 (Panoramic x-ray) is allowed once per beneficiary in a 3 year period, this was previously claimed for in August 2013. With regards to the dental claim dated 15 October 2015, the procedure code 8159 (scale and polish) was inadvertently claimed twice resulting in a short payment, the dental practice has been contacted and an amended account will be submitted to us for correction.
DENIS's reply30 Oct 2015, 15:16
Official
Hello Mtswene,
As telephonically discussed, the dental claim dated 24 March 2015 was short paid as the procedure code 8115 (Panoramic x-ray) is allowed once per beneficiary in a 3 year period, this was previously claimed for in August 2013. With regards to the dental claim dated 15 October 2015, the procedure code 8159 (scale and polish) was inadvertently claimed twice resulting in a short payment, the dental practice has been contacted and an amended account will be submitted to us for correction.
As telephonically discussed, the dental claim dated 24 March 2015 was short paid as the procedure code 8115 (Panoramic x-ray) is allowed once per beneficiary in a 3 year period, this was previously claimed for in August 2013. With regards to the dental claim dated 15 October 2015, the procedure code 8159 (scale and polish) was inadvertently claimed twice resulting in a short payment, the dental practice has been contacted and an amended account will be submitted to us for correction.